Sugar should be regulated like alcohol, tobacco

Like alcohol and tobacco, sugar is a toxic, addictive substance that should be highly regulated with taxes, laws on where and to whom it can be advertised, and even age–restricted sales, says a team of UCSF scientists in Nature. 

For both alcohol and tobacco, there is robust evidence that gentle ‘supply side’ control strategies which stop far short of all–out prohibition – taxation, distribution controls, age limits – lower both consumption of the product and the accompanying health harms. The experts have proposed adding taxes to processed foods that contain any form of added sugars. 

Over the past 50 years, sugar consumption has tripled worldwide. That’s also helped contribute to the obesity epidemic – so much so that there are 30 percent more obese people in this world than there are malnourished people.

Sugar is ‘toxic,’ particularly in excessive amounts, noting that it poses dangers similar to those of alcohol. Fructose, specifically, can harm the liver and overconsumption has been linked with all the diseases involved with metabolic syndrome: hypertension, high triglycerides, insulin resistance, and diabetes. (Source AMA News)

Pioglitazone back

As expected, the Indian government has revoked its suspension of the type 2 diabetes drug pioglitazone. However, it has stipulated that the agent should not be used as first-line treatment for diabetes and that it should carry a boxed warning relating to bladder cancer.

The decision to suspend the manufacture, sale, and distribution of pioglitazone in India, citing concerns over adverse effects, particularly bladder cancer, came out of the blue in June and was widely criticized by doctors and others there. In mid-July, however, a meeting of the drug technical advisory board (DTAB) recommended that pioglitazone be put back on the market.

Now, the Ministry of Health and Family Welfare has announced that all formulations containing pioglitazone for human use are allowed to be manufactured, sold, and distributed once again, albeit with warnings on the package insert.

The new warnings, which must be listed on pioglitazone formulations in India, will state that patients with active bladder cancer or with a history of bladder cancer and those with uninvestigated hematuria should not receive pioglitazone.

And before starting the drug, individuals should be assessed for known risk factors for bladder cancer, including age, smoking history, exposure to occupational or chemotherapy agents, or previous irradiation of the pelvic region.

Prescribers should also review the use of the agent after 3 to 6 months to ensure that only patients who are deriving benefit from it continue to be treated. 

Pioglitazone should be stopped in patients who do not respond adequately to treatment.

There is also special advice for the use of pioglitazone in elderly patients, which "should be considered carefully before and during treatment because the risk of bladder cancer increases with age." Elderly patients should start on the lowest possible dose "and be regularly monitored because of the risks of bladder cancer and heart failure associated with pioglitazone." (Medscape)

Vitamin D intake associated with reduced risk for Crohn’s disease

Increased intake of vitamin D may significantly reduce the risk for Crohn’s disease (CD) in women, according to an article published online December 12 and in the March issue of the journal Gastroenterology.

• This study involved 72,719 women who returned the 1986 questionnaire. They had data on both vitamin D intake and physical activity and did not have a history of CD or UC.
• Diagnosis of CD was based on a typical history of 4 weeks or longer and was confirmed by radiologic, endoscopic, or surgical evaluation.
• The diagnosis of ulcerative colitis (UC) was based on typical clinical presentation of 4 weeks or more and endoscopic, radiologic, or surgical evaluation.
• Mean age of the participants at baseline was 53 years, mean body mass index (BMI) was 25.4 kg/m2, mean physical activity was 13.2 metabolic hours per week, 94.5% were white and 36.6% never smoked.
• A documented 122 cases of CD and 123 cases of UC were recorded during 1,492,811 person–years of follow–up. The median predicted 25(OH)D level was 27.6 ng/mL.
• Women in the lowest quartile of predicted 25(OH)D level compared with those in the highest quartile had a higher body mass index, were less active, tended to reside in the Northern or Midwestern regions of the United States, and had lower intake levels of dietary or supplemental vitamin D. The median age of diagnosis of CD was 64.0 years; for UC, it was 63.5 years.
• The median interval between assessment of plasma 25(OH) D levels and disease diagnosis was 12 years for UC and 10 years for CD.
• For every 1 ng/mL increase in predicted 25(OH)D level, the risk for CD was reduced by 6%.
• For UC, there was also a reduction in risk, but it was non-significant at 4%.
• Women in the highest two quartiles of 25(OH)D levels had multivariate HRs of 0.50 and 0.55, respectively, for CD
• Each 100 IU/day increase in total intake resulted in a 10% reduction in UC risk and a 7% reduction in CD risk.
• For vitamin D intake from diet and supplements based on quartile distribution, there was a significant linear inverse trend for vitamin D intake and UC risk, but this trend was weaker for CD.
• Intakes of 800 IU/day or higher resulted in greater reductions in the risks for UC and CD
• Vitamin D intake was inversely associated with the risks for CD and UC, vitamin D insufficiency or deficiency was an important mediator in the pathogenesis of UC and CD, and assessment of vitamin D status should be a part of the assessment of inflammatory bowel diseases.

Artificial sweeteners can cause diabetes

Consumption of non-caloric, artificially sweetened beverages is associated with an increased risk for obesity, type 2 diabetes, metabolic syndrome and cardiovascular disease.

This counterintuitive result reflects negative consequences of interfering with learned relationships between sweet tastes and typical postingestive outcomes, which may result in impaired ability to compensate for energy provided when caloric sweeteners are consumed.

The study by Dr Susan E Swithers at Purdue University, West Lafayette, IN published in July issue of Trends in Endocrinology & Metabolism found an elevated risk for weight gain and obesity, metabolic syndrome, type 2 diabetes, coronary heart disease, and hypertension in those who consumed ASBs. No decreased risk for weight gain or increased body fat percentage was associated with ASB intake.

Mediterranean diet and prevention of cardiovascular disease

A large randomized trial compared three diets in patients at high cardiovascular risk

·        A Mediterranean diet supplemented with olive oil

·        A Mediterranean diet supplemented with mixed nuts

·        Advice to reduce dietary fat 

For the primary composite cardiovascular endpoint of heart attack, paralysis, and sudden death event rates were similar for the Mediterranean diets supplemented with olive oil and mixed nuts, and lower than for the control diet. Although this trial suggests possible substantial cardiovascular benefits from a Mediterranean diet, there was a surprisingly large reduction in events, a low total number of events, and the trial was stopped early for benefit after a median follow-up of 4.8 years.  

A Mediterranean diet is typically high in fruits, vegetables, whole grains, beans, nuts, and seeds and includes olive oil as an important source of fat; there are typically low to moderate amounts of fish, poultry and dairy products, and there is little red meat.

Even the elderly should exercise

Research spanning two decades has found that older runners live longer and suffer fewer disabilities than healthy non–runners. This observation applies to a variety of aerobic exercises, including walking.

A study by authors, from Stanford University School of Medicine, published in Archives of Internal Medicine has shown that being active reduces disability and increases survival.

There are benefits of vigorous activity late in life. Earlier many experts believed that vigorous exercise would actually harm older individuals. And running, in particular, would result in an epidemic of joint and bone injuries. But this new study proves otherwise.

Two hundred and eighty–four runners and 156 healthy "controls," or non–runners, in California completed annual questionnaires over a 21–year period. The participants were 50 years old or over at the beginning of the study and ran an average of about four hours a week. By the end of the study period, the participants were in their 70s or 80s or older and ran about 76 minutes a week.

At 19 years, just 15 percent of the runners had died, compared with 34 percent of the non–runners.

In the study,  running delayed the onset of disability by an average of 16 years. It’s so important to be physically active your whole life, not just in your 20s or 40s, but forever. Exercise is like the most potent drug. Exercise is by far the best thing you can do.

One should take lessons from Yudhishtir in Mahabharata who walked till his death.

However a word of caution, if an elderly is walking or entering into an exercise program, he or she should have a cardiac evaluation to rule out underlying heart blockages.

Why one year compulsory rural posting before PG is not the answer

1. There are one lakh doctors waiting for PGs in the country for only 12000 PG seats as per IMA.

2. As per an RTI only less than 3000 posts are vacant in rural areas.

3. It will lead to capitation fee in rural service and will add to the already high corruption in the medical profession.

4. Another one year of medical study will add to more misery for the students.

5. Safety of female students will be compromised.

6. Why can’t the PG exam take place along with the final MBBS exam or mid way in internship after you finish 6 months clinical postings. Rest six months and first six months of PG can be a rural posting and the exam of PG can be linked to rural posting experiences.

Survey by Medical Students Association of India, participated by 11727 students, with 8963 medical students, 6451 males.

1. 99% do not agree with the government proposal.

2. 79% want government to cancel the move.

3. None of them said that they oppose to serve in the rural areas but do not want to link it to education entry.

4. 32% said that this move will lead to one more additional year to waste.

5. 19% said that the infrastructure is not ripe for rural postings at this age.

6. 15% said that the family cannot afford one more year of study.

7. 4% said that they are getting old and cannot afford additional year of posting.

8. 4% said that rural posting is not incentive-based.

9. 58% said that even if they were paid double the amount they would not accept a rural posting

10. 92% said that the government should first infuse money and make the infrastructure better.

11. 92% said that after one year of rural service, it will be too late to join PG.

12. Over 70% said that making it a six-month posting will not matter.